Sudanese women have one of the highest maternal mortality rates in the world and desperately need medical help and education, the country head of the U.N. population fund (UNFPA) said on Tuesday.

Nimal Hettiaratchy said Sudan’s first International Women’s Day since signing a historic peace deal in January to end more than two decades of war in its south should be used to promote equality for women.

“There’s no point in having development for dead bodies,” he told Reuters after addressing a gathering of hundreds of women and Vice President Moses Machar in Khartoum.

“The maternal mortality rate for women in Sudan is one of the highest in the world.”

The Sri Lankan said on average, 509 Sudanese women per 100,000 died while giving birth. In Kassala, in Sudan’s east, the figure was as high as 2,284, according to local authorities.

He said a lack of trained midwives was one reason for the high mortality rate. There are about 8,000 midwives in Sudan, but the country of around 30 million needs more than twice that number, he said.

The prevalence of female genital mutilation (FGM), which involves the partial or complete removal of the external female genitalia, contributed to complications and death during childbirth.

On average, 90 percent of Sudanese women have undergone FGM and most are subjected to a severe form of cutting called “pharaonic”, which involves the woman being stitched up afterwards.

“This can lead to obstruction (in childbirth) which often results in death because the woman cannot get to health facilities to have a caesarean or the woman will bleed to death,” Hettiaratchy said.

He said education was desperately needed to stop the practice. Outside of the capital Khartoum, there was also little access to health facilities.

The lack of facilities and transport in Sudan, Africa’s largest country, meant many women who experienced complications during childbirth did not get medical help in time.

“I’ve seen a woman who bled to death on a donkey because she could not get to a clinic in time,” he said. Due to the bloody southern civil war, Sudan’s south is bereft of infrastructure, including roads, schools and health facilities.